The American journal of emergency medicine
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Randomized Controlled Trial
Sub dissociative dose of ketamine with haloperidol versus fentanyl on pain reduction in patients with acute pain in the emergency department; a randomized clinical trial.
Ketamine is known to be an effective factor in reducing pain without significant side effects. ⋯ Ketamine works better than fentanyl in controlling acute pain, and limited side effect of agitation can be controlled if injected with haloperidol. Due to its better function and fewer side effects, it seems that in controlling acute pain, Ketamine along with Haloperidol can be a good alternative to opioids.
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Traumatic arthrotomy (TA) is a rare but serious condition associated with a high morbidity and mortality that can be mitigated with prompt diagnosis and appropriate management. ⋯ An understanding of an evidenced-based approach to TA can assist emergency clinicians in diagnosing and managing this challenging clinical presentation.
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Randomized Controlled Trial
Retromolar intubation with video intubating stylet in difficult airway: A randomized crossover manikin study.
Difficult airway situations, such as trismus and neck rigidity, may prohibit standard midline orotracheal intubation. An alternative route of intubation from the retromolar space using a fiberoptic scope or rigid intubation stylet has been reported. There is no study investigating the applicability of retromolar intubation using a video intubating stylet. This study comparatively analyzed difficult airway management using a video intubating stylet in the retromolar and standard midline approaches. ⋯ The retromolar approach for intubation using a video intubating stylet may be a promising choice for selected patients with a combination of difficult airway features such as limited mouth opening, neck rigidity, and edematous tongue.
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Review Case Reports
Local anesthetic systemic toxicity in the pediatric patient: A case report and review of the literature.
Lidocaine and prilocaine are local anesthetics, a class of medications which are frequently used in clinical medicine to minimize pain in a variety of procedures. They are commonly found in over-the-counter products such as topical anesthetic creams advertised to relieve localized muscle and joint pain. While safe and well-tolerated when used appropriately, an overdose of these anesthetics increases the risk for local anesthetic systemic toxicity (LAST), which in severe cases can present with seizures, cardiac dysrhythmias, and ultimately cardiovascular collapse. ⋯ After stabilization, the patient was transferred to the Pediatric ICU and ultimately made a complete recovery. LAST is a life-threatening presentation which requires early recognition by clinicians, as well as an understanding of the appropriate treatment modalities. We review the assessment and management of LAST, with special focus on the pediatric patient.
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Neonatal diabetes mellitus (NDM) is a rare disease distinct from type 1 diabetes mellitus (T1DM). While T1DM results from autoimmune destruction of pancreatic beta cells, NDM arises from genetic mutations to insulin production and secretion pathways. We present a case of an infant presenting to the emergency department with shock and poor responsiveness, found to have neonatal DM with hyperosmotic hyperglycemic syndrome (HHS). This report distinguishes NDM from T1DM, illustrating the subtle but clinically significant differences in pathophysiology and implications for initial management of NDM in the emergency department setting.